Cost and quality of diabetes care: comparisons between Rzeszow, Podkarpacie, Poland and Waukesha, Wisconsin, United States

Abstract

Background. The cost of diabetes care increases worldwide and is highest in the United States (US), while the quality of care remains unsatisfactory. The aim of this study was to compare the quality and cost of type 2 diabetes mellitus (DM) care between Waukesha, Wisconsin, US and Rzeszow, Poland. Methods. DM quality data for the Polish cohort were abstracted from the charts of 79 DM patients in Rzeszow, Podkarpacie from 1 January 2013 to 31 December 2014. Cost data were attained from the Polish National Health Fund. Seventy-nine DM patients, matched for age, body mass index, and sex, from Waukesha, Wisconsin were chosen as comparators. DM quality data was obtained from the medical record and cost data from health system decision support staff. Results. Average HbA1c (%, mean ± SD) in the Polish and US cohorts were 7.4 ± 1.4 and 8.0 ± 2.1, respectively (P = 0.03). Mean systolic/diastolic blood pressure (mm Hg) in the two cohorts was 150 ± 17/81 ± 12 and 132 ± 17/74 ± 11 (P < 0.001), respectively. The rates of statin usage were 90% and 86% (P = 0.45), respectively. Costs of direct medical care (hospitalizations, outpatient care, and medications) in the Polish and US cohorts were 1,263 US dollars (USD) and 10,121 USD, per annum, respectively. Conclusion. This study reports significant differences in cost with relatively small differences in quality and of DM care between Poland and the US. As the US continues to attempt healthcare reform in order to decrease cost and increase quality, this study suggests that gains in cost and quality may not be mutually exclusive.